NPIMap

Organization Active NPI

Potentials, LLC

  • Community/Behavioral Health Agency
  • Astoria, OR
National Provider Identifier
1710173802
Registry record updated Sep 21, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
C1489 Issued in OR
Legal business name
POTENTIALS, LLC
Practice address
100 39TH St Pier 39
Astoria, OR 97103-2499
Phone
(503) 325-2398
Fax
(503) 325-5932
NPI assigned
Sep 21, 2007
Last updated
Sep 21, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Dana S Dedolph, MA, LPCNPI 1851671960
Title
Director/Therapist
Phone
(503) 325-2398

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X C1489 OR Primary

Addresses

Primary practice location

100 39TH St Pier 39
Astoria, OR 97103-2499

Mailing address

100 39TH St Pier 39
Astoria, OR 97103-2499
Phone (503) 325-2398

National Provider Directory

National Provider Directory

Locations

100 39th St
Pier 39
Astoria, OR 97103
Phone (503) 325-2398

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190332800000",
    "number": "1710173802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 39TH ST PIER 39",
            "city": "ASTORIA",
            "state": "OR",
            "postal_code": "971032499",
            "telephone_number": "503-325-2398",
            "fax_number": "503-325-5932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 39TH ST PIER 39",
            "city": "ASTORIA",
            "state": "OR",
            "postal_code": "971032499",
            "telephone_number": "503-325-2398",
            "fax_number": "503-325-5932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTENTIALS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-21",
        "last_updated": "2007-09-21",
        "status": "A",
        "authorized_official_last_name": "DEDOLPH",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "DIRECTOR/THERAPIST",
        "authorized_official_telephone_number": "503-325-2398",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MA, LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "OR",
            "license": "C1489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Astoria, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.